Idiopathic intracranial hypertension (pseudotumor cerebri)

Posted by e-Medical PPT Thursday, October 28, 2010
Idiopathic intracranial hypertension or benign intracranial hypertension(pseudotumor cerebri),is a neurological disorder that is characterized by increased intracranial pressure in the absence of a tumor or other diseases.
The most common symptom of BIH is headache, which occurs in almost all cases.Many have pulsatile tinnitus, a whooshing sensation in one or both ears (64–87%); this sound is synchronous with the pulseVarious other symptoms, such as numbness of the extremities, generalized weakness, loss of smell, and incoordination, are reported more rarely; none are specific for BIH.In children, numerous nonspecific signs and symptoms may be present.
The increased pressure leads to compression and traction of the cranial nerves, a group of nerves that arise from the brain stem and supply the face and neck. Most commonly, the abducens nerve (sixth nerve) is involved. This nerve supplies the muscle that pulls the eye outward. Those with sixth nerve palsy therefore experience horizontal double vision which is worse when looking towards the affected side. More rarely, the oculomotor nerve and trochlear nerve are affected; both play a role in eye movements.The facial nerve is affected occasionally.
The increased pressure leads to papilledema, which is swelling of the optic disc.This occurs in practically all cases of IIH, but not everyone experiences symptoms from this. Those who do experience symptoms typically report "transient visual obscurations", episodes of difficulty seeing that occur in both eyes but not necessarily at the same time. Long-term untreated papilledema leads to visual loss, initially in the periphery but progressively towards the center of vision.
BIH is diagnosed with a brain scan and a lumbar puncture; lumbar puncture may also provide temporary and sometimes permanent relief from the symptoms. Some respond to medication (with the drug acetazolamide), but others require surgery to relieve the pressure. The condition may occur in all age groups, but is most common in young women, especially those with obesity.

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